Building back better: Imagining an occupational therapy for a post‐COVID‐19 world

Abstract

Introduction The COVID‐19 pandemic, which has disrupted occupations and lives of people around the world, has simultaneously exposed deeply rooted social inequities and structural injustices that have negated the facile claim that “we're all in this together.” But the pandemic has also opened up opportunities to imagine other ways of living and doing in the future. This paper imagines some possibilities for shaping occupational therapy's future practices and seeks to illustrate why it is both timely and necessary to re‐imagine occupational therapy in 2021. Methods Drawing from epidemiological research, the paper explores the inequitable impacts of COVID‐19, environmental degradation, and multiple social determinants on people's real opportunities for health, wellbeing, and occupational engagement. Findings Evidence presented in this paper challenges occupational therapy's individualised approach towards wellbeing and contests the limited parameters of occupations “that matter” that are prioritised and promoted within the profession. In response, the paper seeks to expose the specific, political, economic, and ableist ideology that has effectively shaped the occupational therapy profession's assumptions, models, theories, and the practices these inform. Conclusion Drawing from the “Build back better” approach to post‐disaster recovery—with its dual attentions to wellbeing, equity, and inclusivity and to physical, social, cultural, economic, and environmental vulnerabilities—this paper imagines an occupational therapy for a post‐COVID‐19 world; an occupational therapy that takes seriously the premise that occupations and people are inseparable from their environments; a profession that no longer colludes in individualising problems that are inherently social or in depoliticising the systemic social and economic inequalities that create stress and illness; an occupational therapy that no longer promotes the values of neoliberal ableism; and an occupational therapy dedicated to expanding people's just and equitable opportunities to engage in meaningful occupations that contribute positively to their own wellbeing and the wellbeing of their communities.

Reframing well‐being: Lessons from Aotearoa New Zealand's first wave COVID‐19 response

“…Joseph and McGregor (2020, p.14) argue that “there is currently an ideological struggle over the idea of wellbeing”. One where the Western ideology of ‘the individual’ (living well) dominates and is promoted, and in which neoliberalism plays a central role (Joseph and McGregor, 2020; Mulgan et al ., 2021; Shakespeare et al ., 2021; Whalley Hammell, 2021). For many of our participants however, the individual was not the focus of their narrative and the COVID‐19 lockdowns highlighted to them that the neoliberal economy was a very narrow and limited way of organising life and deciding what is and is not valuable.…”

“…Globally, the COVID‐19 pandemic has exposed profound social inequalities and structural injustices, but it has also provided the opportunity to reimagine possibilities for a better future (Clark and Gruending, 2020; Whalley Hammell, 2021). There has been a strong call in the international literature to build back better post‐COVID‐19 (e.g., Clark and Gruending, 2020; OECD, 2020; Jenkins and Smith, 2021; Mulgan et al ., 2021; Whalley Hammell, 2021). Well‐being is a central dimension of building back better (OECD, 2020).…”

Dissolving Ableism: Could Disabled People Flourish During the First Aotearoa New Zealand COVID-19 Lockdown?

“…For example, the first Aotearoa New Zealand lockdown was a particular societal response to an event that created certain conditions with the potential to enable disabled people to flourish. Learning from events that disrupt disabling conditions can enable us to better prepare and “build back better” (Whalley Hammell, 2021; WHO, 2013) to “improve the lives of disabled people, assert social rights more clearly, and to facilitate social and economic integration” (Priestley & Hemingway, 2007, p. 31). Such opportunities should not be squandered.…”

“…The unprecedented and sudden change in how we live and work illustrates that we, as a society, do indeed possess the capacity to challenge and subvert ableism (Whalley Hammell, 2021). For example, the first Aotearoa New Zealand lockdown was a particular societal response to an event that created certain conditions with the potential to enable disabled people to flourish.…”

“…Second, empowering service culture and provision spaces need to be created. For example, the reimagining of occupational therapy away from its neoliberal foundations and toward promoting equitable well-being for disabled people (Whalley Hammell, 2021). Third, policy developments and behavioral changes enabling flexible working opportunities for disabled people are required.…”